Tsai Chia-Ti, Chang Shu-Hsuan, Chang Sheng-Nan, Hwang Juey-Jen, Wu Cho-Kai, Wang Yi-Chih, Tseng Chuen-Den, Yeh Huei-Ming, Lai Ling-Ping, Chiang Fu-Tien, Lin Jiunn-Lee
Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Division of Cardiology, Department of Internal Medicine, Lotung Poh-Ai Hospital, Yilan, Taiwan.
Heart Rhythm. 2014 Mar;11(3):352-7. doi: 10.1016/j.hrthm.2013.11.014. Epub 2013 Nov 16.
The CHA₂DS₂-VASC scoring scheme may not be better than the CHADS₂ scoring scheme in predicting thromboembolic risk for patients with atrial fibrillation (AF) in Asians. Metabolic syndrome is associated with an increased risk of thrombosis.
To evaluate whether metabolic syndrome offers incremental information over the CHADS₂ scheme in predicting thromboembolic risk for patients with AF in the Taiwanese population.
The study population consisted of 721 consecutive patients with AF who had been followed up for a median of 10.8 years. Thromboembolic end points were defined as ischemic stroke/transient ischemic accident and peripheral embolisms. Clinical factors associated with thromboembolic end points were identified by Cox regression analysis. Different scoring systems were compared by receiver operating characteristic (ROC) analysis.
We found that components in the CHADS₂ scheme were associated with an increased risk of thromboembolism. The CHA2DS₂-VASC scheme did not provide information additional to that provided by the CHADS₂ scheme on thromboembolism risk (ROC area: 0.670 vs 0.665; P > .05). Metabolic syndrome components were also associated with increased risk of thromboembolism. The incident thromboembolic rate increased incrementally when metabolic syndrome score increased. Additional metabolic syndrome components provide additional information to the CHADS₂ scheme on thromboembolism risk (ROC area: 0.670 vs 0.729; P = .034). We therefore proposed a new scoring scheme called CHADS₂-MS scoring scheme. In patients with low to intermediate CHADS₂ scores (0-1), the use of the CHADS₂-MS score may additionally identify patients with high-risk AF for future thromboembolism.
We, for the first time, demonstrated that metabolic syndrome components were associated with thromboembolic risk in Taiwanese patients with AF. In addition to the conventional CHADS₂ scheme, the calculation of the CHADS₂-MS score provides additional information on stroke risk assessment.
在预测亚洲心房颤动（AF）患者的血栓栓塞风险方面，CHA₂DS₂-VASC评分系统可能并不优于CHADS₂评分系统。代谢综合征与血栓形成风险增加相关。
评估在预测台湾人群AF患者的血栓栓塞风险方面，代谢综合征是否能提供超出CHADS₂评分系统的额外信息。
研究人群包括721例连续的AF患者，中位随访时间为10.8年。血栓栓塞终点定义为缺血性卒中/短暂性脑缺血发作和外周栓塞。通过Cox回归分析确定与血栓栓塞终点相关的临床因素。通过受试者操作特征（ROC）分析比较不同的评分系统。
我们发现CHADS₂评分系统中的各项因素与血栓栓塞风险增加相关。CHA2DS₂-VASC评分系统在血栓栓塞风险方面并未提供超出CHADS₂评分系统的额外信息（ROC曲线下面积：0.670对0.665；P>.05）。代谢综合征各组分也与血栓栓塞风险增加相关。随着代谢综合征评分增加，血栓栓塞发生率逐步上升。代谢综合征的额外组分可为CHADS₂评分系统提供关于血栓栓塞风险的额外信息（ROC曲线下面积：0.670对0.729；P=.034）。因此，我们提出了一种新的评分系统，即CHADS₂-MS评分系统。在CHADS₂评分较低至中等（0-1）的患者中，使用CHADS₂-MS评分可能有助于额外识别未来发生血栓栓塞的高危AF患者。
我们首次证明，代谢综合征组分与台湾AF患者的血栓栓塞风险相关。除了传统的CHADS₂评分系统外，CHADS₂-MS评分的计算为卒中风险评估提供了额外信息。
